Scale & Polish
It is essential for Health & Safety reasons that all of the veterinary team involved in a dental procedure are fully protected. Face masks and eye protection are a requirement - gloves, hats and scrub suits are also advisable.
Our patients must be anesthetised to properly perform a dental scale and polish – as later sections will demonstrate.
Often dental patients are elderly and a pre-operative blood screen may be desirable to check kidney function (the kidneys often seem to be affected by infection spreading from the mouth).
Usually a pre-medication will be used. This will dramatically reduce the dose of anaesthetic that is then required. The sedation produced also allows a fuller examination of the mouth than is often possible in a conscious (even well behaved) patient.
With sedation the gums do not look as red an angry as they did in the conscious patient. But the inflammatory changes to the gums around the build-up of calculus (or tartar) is easy to see.
Have you spotted the fractured incisor tooth?
Patients are then induced to full anaesthesia, then an endo-tracheal (ET) tube is placed into the wind-pipe. This carries oxygen and anaesthetic gasses down into the lungs.
Importantly, for dental procedures, a cuffed tube should be used in all but the smallest patients. The picture shows a cuff being inflated with air from the syringe. This cuff helps to form a gentle seal in the trachea (wind-pipe) to help prevent the inhalation of water and debris.
To add further protection a "throat pack" of gauze swabs or similar absorbent material is placed around the tube.
This helps to ensure that no debris or water is inadvertently carried down into the lungs.
The throat pack is changed repeatedly during the procedure as it absorbs water and starts to accumulate material.
The various monitors are put in place and we are ready to proceed with the dental procedure. It is important to note that there are always at least two members of staff - one monitoring the depth of anaesthesia and the vital signs and the other actually carrying out the dental procedure.
Where extractions are required a Veterinary Surgeon will always be involved and a qualified veterinary surgeon will always be in overall charge of the anaesthetic. In this picture you can see the veterinary surgeon carrying out the dental procedure and the trainee nurse monitoring the anaesthetic. You can also see the dental x-ray unit, the high speed iM3 dental air unit and the 42/12 ultrasonic scaler, together with pulse oximetry, blood pressure, respiration & ECG monitoring.
In order to reduce the bacterial burden – both for the patient and for the veterinary staff, the mouth is now rinsed with an antiseptic solution.
Large masses of calculus can sometimes be "cracked off" using special dental forceps. Care has to be taken not to damage the gums in this procedure. The lumps of debris show why it is important to protect the patient's airway.
After this (or before) it is important to probe the periodontal pocket. This is the area between the tooth and the gum. In disease the pocket can increase in depth and probing also helps to reveal how much inflammation is present. All of the edges of the tooth should be probed.
Not forgetting the inside surface (where a dental mirror can come in very handy)
The teeth can be hand scaled – but most veterinary practices will use a powered scaler. An excellent machine is the 42/12 which is both very powerful – but also gentle to the tissues. Its cooling jet of water allows the tip to be used in the periodontal pocket.
The aerosol that the scaler produces is another reason why the pet's airway has to be protected – and why staff have to wear eye protection and face masks.
The combination of water and the ultrasonic vibration of the tip creates a process called cavitation which breaks off the calculus from the tooth's surfaces. Again – it is important not to neglect the inside surfaces of the teeth.
The throat pack is regularly changed – as it can quickly become waterlogged and covered with debris.
Before placing a new throat pack in place the mouth is carefully cleaned to remove debris.
Special hand instruments called "Curettes" are used to clean the periodontal pocket.
These have a curved outer surface to avoid damage to the gum – whilst the inside surface is sharp to allow the surface of the tooth to be properly cleaned.
These instruments can be carefully placed below the gum line and used to clean the all important periodontal pocket.
Some (and only the most modern and sophisticated) ultrasonic scalers can also be used below the gumline in the hands of suitably trained staff. The 42/12 is designed to be used below the gumline and the jet of water reaches to the tip for both cooling and a proper cavitational effect.
After the teeth and the periodontal space have been properly cleaned – the teeth should be polished to remove any tiny scratches that make it easier for plaque to reform.
Once more the inside surfaces of the teeth cannot be forgotten.
The mouth is once again rinsed with a antiseptic solution, the throat packs are carefully removed and the mouth cleaned and the pets are gently woken up from the anaesthetic.
Home care and prevention are now the key words to try and prevent your pet needing another scale and polish.
Use of a proper diet, toothbrushing and regular oral hygiene chews can all help limit the effects of dental disease.
Prevention is better than treatment.
But don't delay treatment - things get worse!
Did You Know?
Spot the Lesion
Colour changes to the tooth and pimple to the gum - a tooth root abscess.